What about anticoagulation in patients at high risk for bleeding?
Although elderly patients are at high risk for bleeding they are also at high risk for stroke from atrial fibrillation; thus, age is not a contraindication to anticoagulation.
Contraindications include history of severe gastrointestinal (GI) bleeding, history of falls, or an extremely high fall risk.
The HAS-BLED score is a simple method for assessing bleeding risk. After stroke, many patients are at risk for falls: as they recover, reconsider anticoagulation.
The decision for anticoagulation should be an ongoing collaborative discussion of the risks, benefits, and monitoring schedule so that the patient can make an informed decision.